Family Functioning and Mental Illness: A Comparison of Psychiatric and Nonclinical Families

The primary objective of the present investigation was to examine adaptive functioning in the families of patients with a wide range of psychiatric disorders. Seven dimensions of family functioning, as measured by the Family Assessment Device (FAD), were compared across families of patients with a schizophrenia spectrum disorder (n = 61 ), bipolar disorder (n = 60 ), major depression (n = 111 ), anxiety disorder (n = 15 ), eating disorder (n = 26 ), substance abuse disorder (n = 48 ), and adjustment disorder (n = 46 ). Families in each psychiatric group were also compared to a control group of nonclinical families (N = 353 ). Results indicated that regardless of specific diagnosis, having a family member in an acute phase of a psychiatric illness was a risk factor for poor family functioning compared to the functioning of control families. However, with few exceptions, the type of the patient's psychiatric illness did not predict significant differences in family functioning. Thus, having a family member with a psychiatric illness is a general stressor for families, and family interventions should be considered for most patients who require a psychiatric hospitalization for either the onset of, or an acute exacerbation of, any psychiatric disorder.     

BEHAVIORAL CUSPS: A DEVELOPMENTAL AND PRAGMATIC CONCEPT FOR BEHAVIOR ANALYSIS

Most concepts of development explain certain behavior changes as products or markers of the invariable succession of emerging periods, stages, refinements, or achievements that define and order much of an individual's life. A different but comparable concept can be derived from the most basic mechanisms of behavior analysis, which are its environmental contingencies, and from its most basic strategy, which is to study behavior as its subject matter. From a behavior-analytic perspective, the most fundamental developmental questions are (a) whether these contingencies vary in any systematic way across the life span, and thus make behavior change in a correspondingly systematic way; and (b) whether some of these contingencies and their changes have more far-reaching consequences than others, in terms of the importance to the organism and others, of the behavior classes they change. Certain behavior changes open the door to especially broad or especially important further behavior change, leading to the concept of the behavioral cusp. A behavioral cusp, then, is any behavior change that brings the organism's behavior into contact with new contingencies that have even more far-reaching consequences. Of all the environmental contingencies that change or maintain behavior, those that accomplish cusps are developmental. Behavior change remains the fundamental phenomenon of development for a behavior-analytic view; a cusp is a special instance of behavior change, a change crucial to what can come next.     

DIRECT AND COLLATERAL EFFECTS OF RESTRAINTS AND RESTRAINT FADING

Mechanical restraints are commonly used to reduce the risks associated with severe self-injurious behavior (SIB), but may result in movement restriction and adverse side effects (e.g., bone demineralization). Restraint fading may provide a method for decreasing SIB while increasing movement and reducing these side effects. In the current investigation, rigid arm sleeves and restraint fading (gradually reducing the rigidity of the sleeves) were used with 3 clients who engaged in hand-to-head SIB. Restraints and fading reduced the hand-to-head SIB of all clients. However, for 1 client, the addition of a water mist procedure further reduced SIB to near-zero levels. For a 2nd client, another form of SIB developed that was not prevented by the rigid sleeves. For a 3rd client, a topography of SIB that was not physically prevented by the rigid sleeves was also reduced when restraints and fading were introduced.     

The Development of a Clinical Rating Scale the McMaster Model of Family Functioning

This article describes the development and validation of the McMaster Clinical Rating Scale (MCRS). The MCRS is a 7-item scale designed to be completed by a trained rater after completion of an in-depth interview of the family. We present data from four new studies and review previously published articles concerning the reliability, validity, and clinical utility of the MCRS. Adequate interrater reliability and rater stability were obtained. The MCRS was found to correlate significantly with the self-report Family Assessment Device and to discriminate between families in different phases of a depressive disorder.     

Self- and cross-citations in the Journal of Applied Behavior Analysis and the Journal of the Experimental Analysis of Behavior: 1983-1992

We examined self- and cross-citation practices in JABA and JEAB from 1983 through 1992. Mean levels of self-citation for JABA and for JEAB were 22.6% and 36.1%, respectively. Overall, 2.4% of JABA citations were JEAB articles, and 0.6% of JEAB citations were JABA articles, which suggests limited integration of basic and applied research.     

BALANCING SOCIAL ACCEPTABILITY WITH TREATMENT EFFECTIVENESS OF AN INTRUSIVE PROCEDURE: A CASE REPORT

The debate over social acceptability of intrusive procedures has led some school districts to adopt policies allowing punishment for only the most extreme forms of destructive behavior. We investigated the effectiveness of selectively implementing punishment for only the most severe topographies of aggression and property destruction, while less extreme behaviors were ignored. Results indicated that severe behaviors were reduced to near-zero levels only when both severe and less severe behaviors were similarly punished.